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Cited by 630Physical Activity and HealthCardiac Health and Mental HealthMeta-analysis and systematic reviews

Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study

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Naci, H., Ioannidis, J. P. A.·2013·BMJ
DOI 10.1136/bmj.f5577PMC PMC3788175
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Abstract

OBJECTIVE: To determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes. DESIGN: Metaepidemiological study. ELIGIBILITY CRITERIA: Meta-analyses of randomised controlled trials with mortality outcomes comparing the effectiveness of exercise and drug interventions with each other or with control (placebo or usual care). DATA SOURCES: Medline and Cochrane Database of Systematic Reviews, May 2013. MAIN OUTCOME MEASURE: Mortality. DATA SYNTHESIS: We combined study level death outcomes from exercise and drug trials using random effects network meta-analysis. RESULTS: We included 16 (four exercise and 12 drug) meta-analyses. Incorporating an additional three recent exercise trials, our review collectively included 305 randomised controlled trials with 339,274 participants. Across all four conditions with evidence on the effectiveness of exercise on mortality outcomes (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of diabetes), 14,716 participants were randomised to physical activity interventions in 57 trials. No statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. Physical activity interventions were more effective than drug treatment among patients with stroke (odds ratios, exercise vanticoagulants 0.09, 95% credible intervals 0.01 to 0.70 and exercise v antiplatelets 0.10, 0.01 to 0.62). Diuretics were more effective than exercise in heart failure (exercise v diuretics 4.11,1.17 to 24.76). Inconsistency between direct and indirect comparisons was not significant. CONCLUSIONS: Although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.

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  • In the general population, physical activity and exercise are broadly as effective as pharmacological interventions in preventing cardiovascular disease and reducing mortality.

    “In the general population, there is evidence that physical activity and its structured form, exercise, are broadly as effective as pharmacological interventions in preventing cardiovascular disease and reducing mortality 6 .”

    From Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis (2017) · cites this paper as [6]

    The Discussion reports that exercise was potentially similar to drug interventions for mortality outcomes in the conditions studied. It also says the evidence was limited to secondary prevention of coronary heart disease, stroke rehabilitation, heart-failure treatment, and diabetes prevention. That does not establish comparable effectiveness for preventing cardiovascular disease in the general population. (LLM, conf=0.89)

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  • In the general population, exercise can reduce the risk of cardio-metabolic diseases such as obesity, diabetes and metabolic syndrome.

    “Specifically, there is a plethora of evidence from the general population that exercise can reduce the risk of cardio-metabolic diseases (such as obesity, diabetes and metabolic syndrome [92,93]).”

    From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [92]

    The Introduction (page not provided) describes population-level health benefits of exercise and discusses physical activity as a way to ward off chronic conditions including diabetes and heart disease. It does not address reduced risk of obesity or metabolic syndrome, the other examples attributed to this source. (LLM, conf=0.84)

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Authors
Naci, H., & Ioannidis, J. P. A.
Affiliations
  • Harvard University (US)
  • Stanford Medicine (US)
Corresponding author
Naci, H.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2013-10-01
Volume
347
Issue
oct01 1
Pages
f5577-f5577
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.f5577
PMC
PMC3788175
OpenAlex
W2902275236
Cited by
630
References
86
Citations by year
2026: 9 · 2025: 20 · 2024: 33 · 2023: 22 · 2022: 39 · 2021: 40 · 2020: 57 · 2019: 48 · 2018: 71 · 2017: 59 · 2016: 84 · 2015: 80 · 2014: 59 · 2013: 8
FWCI
53.61
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion, cc-by-nc)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Keywords
exercise intervention, pharmacological interventions, mortality, comparative effectiveness, physical activity, stroke rehabilitation, heart failure treatment, diabetes prevention, prediabetes, anticoagulants, antiplatelet therapy, diuretics
MeSH terms
Anticoagulants, Cardiovascular Agents, Coronary Disease, Diuretics, Exercise Therapy, Female, Heart Failure, Humans, Hypoglycemic Agents, Male, Mortality, Platelet Aggregation Inhibitors, Prediabetic State, Research Design, Confounding Factors, Epidemiologic, Odds Ratio, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Stroke, Comparative Effectiveness Research

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